Your Healthcare Costs | NYC Health + Hospitals

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Your Healthcare Costs

Shopping for Your Services & Price Transparency

At NYC Health + Hospitals we are committed to providing you with the best information possible so you can make informed decisions about your care.  This includes providing you with a list of hospital charges and an estimate of out-of-pocket costs for the most common services we provide.

You can obtain an estimate of your out-of-pocket costs for many services before your visit via MyChart or by calling 1-844-692-4692 and selecting option 3 to speak to a financial counselor. Our staff can help provide a comprehensive estimate based on your health insurance coverage and benefits information and your financial situation.

Regardless of how you obtain an estimate, always remember that financial concerns should not keep you from receiving the care you need. If you can’t afford to pay the estimated amount, ask to speak to a financial counselor by calling 1-844-692-4692. Reduced prices may be available on a self-pay basis in some circumstances.

Understanding Your Out-of-Pocket Costs

Your out-of-pocket cost for health care services may depend on several factors including:

  • the services or procedures you receive
  • the NYC Health + Hospitals site where you receive the services
  • your current health insurance coverage, including applicable copayment, co-insurance, deductible and the limit of out-of-pocket expense requirements
  • your eligibility for insurance or other financial assistance

Understanding Health Care Charges

Hospital/Facility and Professional Charges

For services provided at NYC Health + Hospitals, you or your insurer will may receive separate bills for:

  • Hospital/Facility Charges – includes the cost of your hospital stay, ancillary services (laboratory, radiology), medications, support staff, and supplies
  • Professional Charges – includes charges from NYC Health + Hospitals employed providers such as primary care physician, anesthesiologists, pathologists, oncologists or other specialist physicians and practitioners who have provided your care at an NYC Health + Hospitals site

What are standard charges and how do they impact you?

Standard Charges are the dollar amount a hospital provider sets for services they provide as listed on a Charge Master. The standard charge may be different from the amount paid to the hospital by an insurer that negotiates payment for services covered by its insurance plan, including Medicare and Medicaid plans, or paid by a patient for a service. Patients covered by Medicare, Medicaid and commercial insurance plans usually pay for only a portion of the services provided based on their insurance coverage as a copayment, coinsurance or deductible. Copayments, coinsurance and deductibles are part of the out-of-pocket expenses which you may be responsible to pay to NYC Health + Hospitals. Uninsured patients who qualify for financial assistance and patients paying for services not covered by or outside of their insurance may be eligible for discounted, self-pay prices.

We want to let you know that a new federal regulation requires hospitals to make available a list of their standard charges for items and services provided. These standard charges do not reflect how much you as a patient will have to pay to NYC Health + Hospitals for those items and services.

Hospitals are also required to make available applicable negotiated charges with contracted insurers for inpatient admissions and outpatient visits. These negotiated charges do not reflect how much you as a patient with coverage from the insurer will have to pay to NYC Health + Hospitals as out-of-pocket costs. These charges also may not reflect the actual amount ultimately paid by insurers.  You can access the list here.

  • Inpatient reimbursement is determined by the Federal Diagnosis Related Groups (DRGs)
  • Outpatient reimbursement is based upon the assigned CPT/HCPCS codes associated with the visit

NYC Health + Hospitals also maintains a cost estimator tool for patients which provides an estimated out-of-pocket cost to you for the most frequently provided services that may be scheduled in advance. These services are also referred to as “shoppable services.” This estimated out-of-pocket cost is based on your insurance coverage information or self-pay status at the time of your request for the cost estimate. This estimate does not represent a guaranteed price or coverage of the services by your insurance plan, but includes an estimate of the charge the insurer has negotiated for the service, as applicable. The actual out-of-pocket cost to you may vary based on your health insurance coverage and benefits, medical condition and any additional tests or procedures ordered by your physician at the time of the service. You can access the cost estimator tool here.